The Exchange System provides a quick way to estimate energy, carbohydrates, protein and fat content in any food or meal. Food from each exchange (starch, meat & meat substitute, fruit, vegetable, milk and fat) is defined so that one serving of each food contains the same amount of carbohydrate, protein, fat and energy (calories).

Many vegetables are considered "free" foods, including celery, lettuce, spinach, cabbage, cucumbers and zucchini. Free foods contain fewer than 20 calories per serving and less than 6 grams of carbohydrate per serving. Free foods do not need to count in calculations when they are eaten in moderation (1-2 servings per meal). The key word is moderation. These foods are not totally calorie free. For example, if one consumes 8 servings of a free food (160 calories), it is equivalent to one English muffin.

Free foods have a high water content. When they are cooked they loose the water and become more concentrated. For example, 1/2 cup raw free vegetables would have fewer calories than 1/2 cup cooked free vegetables. Therefore, cooked free vegetables have smaller portion sizes.

Water loss occurs as heat breaks down the membranes of the cells that compose the food product. As the membranes break, the contents of the cell (including water) leaves forming a more concentrated food item.

Sometimes it's OK to interchange exchanges. The calories and carbohydrate or protein content is the same for one Starch/Bread or one Meat substitute serving used in place of the Skim Milk serving. Also one Starch/Bread has the same calories and carbohydrate as a Fruit exchange. The explanation in the front of the book was done so that the user could understand the flexibility of using the pre-planned vegetarian menus in book 5. Diabetic menus are planned for a whole day, not just an isolated meal. Individual meals can vary, especially if one is carbohydrate counting which some diabetics have been instructed to do.

You can calculate the carbohydrate and protein content of a meal by referring to your exchange booklet and your question below. Protein content is 7 grams in one meat or meat substitute (1 ounce), 8 grams in one Milk, 3 grams in one Starch / Bread and 2 grams in one vegetable.

If you eat humus, you don't need to combine it with a grain at the same meal to get a complete protein. Eat a grain in the same day as the humus. If the lunch meal plan has 1 meat substitute (7 grams protein), 3 Starch / Bread servings (3 grams times 3 servings = 9 grams) and 2 vegetable servings (2 grams times 2 servings = 4 grams), the total lunch has 20 grams of protein. If you need to reduce the protein content at the meal, eliminate a Starch / Bread and substitute a Fruit which has no protein and you will reduce the protein content by 3 grams.

You may want to refer back to your basic exchange booklet that lists foods in each exchange and the quantity of food per serving. If you still need some help making some of these substitutions, see a Registered Dietitian to individualize your needs.

The exchanges that have carbohydrate are Starch / Bread - 15 grams, Fruit - 15 grams, Milk- 12 grams and Vegetable - 5 grams. Refer back to your Exchange Lists for Meal Planning book for more details. If you are carbohydrate counting then you do need to know the carbohydrates per meal.

Each meal in the American Diabetes Associations Month of Meals lists the total exchanges per meal. Number 5 book is vegetarian.

If your protein has been restricted because of an elevated creatinine clearance (reflects breakdown of muscle in the body, which occurs in kidney disease), then you need high biologic value protein which are found in animal products.

Animal sources of protein contain all 8 essential amino acids (complete protein). Egg protein is close to ideal.

If you are eating vegetable sources of protein, you may not be getting complete proteins from one day of meals. Unless you eat soybeans which are complete proteins.

I think it would be beneficial for you to see a Registered Dietitian to work on a plan that considers all your health needs.

Standard pattern is 6 meats (medium fat), 2 milk, 3 starch/bread, 2 vegetables, 3 fruit and 2 fat. You can split the exchanges up into 3 meals or 3 meals and 1 snack. Save 1 bread and / or 1 fruit for a snack. You could reduce the meat by 1 exchange and increase the fat by 1 exchange.

If you need additional assistance with your meal plan, contact a Registered Dietitian who could refresh your knowledge and individualize your meal plan with your likes and dislikes.

I do not have a specific recipe for homemade ice cream for use by diabetics. I would suggest though you try any vanilla frozen yogurt recipe to which you could add fresh or frozen fruit pieces.

A recipe I found for homemade ice cream is as follows: 2 cups whipping cream, 2 cups light cream, 1 cup sugar, 1/1/2 tsp. vanilla extract, 1/8 tsp. salt. If you want to make French ice cream, add 1/2 box of instant pudding dry powder to above. I vary the flavors and fruit I put in the ice cream while freezing.

You could substitute non-dairy creamer (Carnation Liquid Coffee Mate Non-Dairy Creamer 54% fat, 13% saturated fat) and skim milk for the whipping cream (95% fat, 59% saturated fat) and light cream (93% fat, 58% saturated fat) as in above recipe. The fat content would be lower substituting the non-dairy creamer and skim milk for the cream.

You could use 1/2 sugar in the regular recipe. I wouldn't suggest using low calorie sweeteners as you would not get the product to freeze.

The cornstarch is a thickener. Try using sugar free instant pudding mix instead of cornstarch.

Remember that 1/2 cup ice cream is one starch/bread and 1 fat exchanges; 1/3 cup frozen yogurt is one starch/bread.

The usual ingredients in peanut butter are peanuts and salt. Some brands add hydrogenated vegetable oil or sugar.

Peanut butter is made by grinding blanched (no skins), roasted peanuts and adding salt. Hydrogenated (saturated) vegetable oil may be added to prevent the peanut oil from separating out. (Imagine your jar of peanut butter with an added spoonful of shortening in it.) There are several brands of peanut butter available in the refrigerated section of most grocery stores that are really good. They have just peanuts and salt and the oil does not separate out as long as the peanut butter is refrigerated.

One tablespoon of peanut butter is exchanged for one meat and one-half fat exchange. Peanuts contain some protein and fat in the form of peanut oil.

So when you eat peanut butter at a meal, reduce one meat at that meal. Peanut butter is a good breakfast substitute for an egg. Try peanut butter on toast with one-half cup of orange juice for a quick breakfast meal.

While I do not recommend that anyone drink alcohol, it should be limited by your doctor's recommendation. Usually that means two per week for the non-insulin dependent diabetic (NIDDM) who is in good blood glucose control. Either two mixed drinks or two 12 ounce beers or two five ounce glasses of wine.

Your body metabolizes alcohol much in the same way as fat. So, exchange alcohol as follows: 1 1/2 ounce distilled alcohol (brandy, vodka, gin, whiskey, bourbon, scotch or rum) equal two fat exchanges; 12 ounces of beer equals one starch and two fat exchanges; a 12 ounce lite beer equals two fats; 5 ounces of wine equals two fats.

If you look at your Exchange List meal pattern, you will have to exchange one brandy and diet seven for two fats at the meal you have the drink. The total amount of calories should remain the same for that day.

I would like you to consider these suggestions. Pick two different days of the week (i.e. Friday and Monday) to have your two drinks. It will be easier to remember what day of the week today is, than when you last had your two drinks.

If you have an alcoholic drink make sure you eat. Plan to have a meal or snack at the same time. One effect of alcohol is that it shuts off your liver from releasing stored sugar into your blood stream which increases the likelihood of having an insulin reaction. Many of the symptoms of an insulin reaction resemble intoxication (like dizziness, slurred speech, blurred vision, muscle weakness and a shaky feeling).

If you are on insulin or pills, the medication will continue to work and your blood sugar will drop when you drink alcohol and don't eat. Also, some diabetic pills may interact with the alcohol and cause facial flushing.

I would like to recommend a great pamphlet called Diabetes and Alcohol. It is available from the International Diabetes Center, 4959 Excelsior Blvd., Minneapolis, MN 55416. Send for additional educational brochures the Diabetes Center offers.

Most canned soups can be exchanged as follows: one cup reconstituted broth soups equals one starch; one cup reconstituted cream type soups equals one starch and one fat. Soup companies do provide detailed lists of exchanges for each of their soups.

If you are serving homemade broth soup as an accompaniment to a meal, serve one-half cup of solids and one-half cup of broth. If your soup has potato, rice, noodles or dried beans and vegetables, exchange this serving like the canned version, one starch.

If you are instead serving hearty soup as a meal, make sure your soup has: meat chunks; potato, rice, noodles or dried beans; vegetables. A serving could be one and one-half cups of solids and some added broth (one-half to one cup). Exchange this serving as two meats, one starch and one vegetable.

Remember to skim the fat off the soup before serving. If you make the soup a day ahead and refrigerate it overnight, the fat rises to the surface and hardens on top. Use a spoon or one of the new fat attracting mops to skim the fat off your hot soup. Bon Appetit!

You can have hard cheeses. Hard cheese exchanges for meat. Hard cheeses like cheddar, Swiss or American are listed with the high fat meats. High fat meats are higher in fat (8 grams) and higher in calories (100 calories). When you eat one ounce of cheese, you should omit one meat and one-half fat exchange.

If you were to eat a slice of bread and cheese, you could omit spreading margarine or mayonnaise on one of the slices of bread. This would cut out the extra one-half fat exchange in each ounce of cheese.

Other cheeses like mozzarella, ricotta, Neufchatel and Parmesan are medium fat meats. They have an average amount of fat and no extra fat exchanges have to be omitted when you eat these cheeses.

Cheeses, including all cottage cheese, farmers, skim ricotta and diet cheeses, are lean meat exchanges and are similar to chicken or fish.

A diabetic is allowed all varieties of cheese. However, a diabetic with high blood pressure should limit or eliminate cheese from his/her diet.

Yes, as a diabetic, you can eat honey graham crackers. The amount of honey or sugar in most brands of graham crackers (other than chocolate covered) is not considered significant.

Three graham crackers measuring 2 1/2 inches square is equal to one starch exchange. So if you would like, you can eat three grahams instead of one slice of bread. Remember, however, to limit the starch exchanges to the total number of planned for your diabetic diet.

The meat exchanges are divided into three categories: lean, medium fat and high fat. All meat groups have the same amount of protein, which is seven grams. The calorie content varies from 55 calories for lean meats and 75 calories for medium fat to 100 calories for high fat meats. The caloric difference between meats is their fat content. Lean meats have only three grams of fat, medium fat meats have five grams and high fat meats have eight grams of fat. So, the higher fat content in the high fat meats increases the calories. Fat is the most calorie concentrated nutrient at nine calories per gram.

The American Diabetes Association's recommended guidelines for diabetics include a low saturated fat, low cholesterol diet plan. This is because diabetics develop more significant cholesterol deposits (atherosclerosis) in their arteries and at a younger age than non-diabetics do. The cause of this increased rate of atherosclerosis is unknown, but higher sugar or insulin levels in diabetic's blood may be the reason.

To limit your intake of saturated fats and cholesterol, choose mostly lean meats and medium fat meats (poultry, round steak, turkey, fish, lean ground beef - at least 85% lean, cottage cheese, loin pork chops, low fat cheeses such as mozzarella). Limit high fat meats such as marbled steaks, fatty ground beef, spareribs, cold cuts and hard cheeses to three meals per week. Choose three days of the week for your high fat meal so that it will be easier to remember (e.g. Monday, Wednesday, Friday).

Yes, try this trick I learned several years ago from another Registered Dietitian.

Take a look at the back of your hand. Look at the two bones that stick out on the side of your wrists. From that point where your wrist bends, up to your knuckles where your fingers start and as thick as your little finger is wide is the size of approximately three ounces of meat, fish or poultry. The piece of meat should be only as thick as your little finger is wide, looking at your finger from the side. Granted, the sizes of people's hands do vary, but so does their calorie and protein needs. So persons with large hands, especially men, may have hands that would compare to four ounces of meat, but their diet would probably be higher in calories and protein also. You always have your hand with you. So just look at the back of your hand as you reach for a piece of meat. Take a serving as large as the back of your hand and as wide as your little finger. If the meat is served to you, cut off a hand size piece before you start. Push the excess off to the side of your plate and enjoy the hand size piece you cut.

No. Just cutting out sugar and sweets isn't enough for a diabetic to control his or her blood sugar. This total food intake for the day should be proportionate to his weight and activity. It should also take into account his food preferences and life long eating habits.

For instance, if his prescribed diet was for 1800 calories and he only ate two meals of 900 calories each, his blood sugar would probably go higher than desired. Instead, if he ate 3 meals and 1 or 2 snacks, the calorie content at each meal would be much lower at around 500 calories. Also, his blood sugar would be more likely to stay within desired ranges of 120 to 180 milligram percent after meals.

The "Exchange List" was revised in 1989 to more closely match the calorie and nutritional value of foods. The list groups foods that have similar nutritional content, together.

For instance, the fruit exchange includes all fruits that have 60 calories and 15 grams of carbohydrate per serving. Unfortunately, nature did not put the same amount of carbohydrates in each kind of fruit, so the serving size varies between fruits.

The starch exchange includes bread, cereal, rolls, crackers and starchy vegetables like corn and potatoes. One starch exchange has 15 grams of carbohydrate, 3 grams of protein and a trace of fat with 80 calories.

Doctors and dietitians have used the exchanges (milk, vegetable, fruit, starch, meat and fat) nationwide to simplify diabetics' meal plans. Counting calories or grams of carbohydrate while eating is very time consuming and tedious. An Exchange List diet will present you with variety and more likely, nutritional adequacy.

It sounds like you have some more unanswered questions. I would suggest, you both see a dietitian again to answer them. Your husband needs to know what and how much he can eat. You need to know what and how much to cook. Once you get used to using exchanges, I believe, you will rely on them for every meal.